Objectives: Cytoreductive nephrectomy for metastatic renal cell carcinoma (mRCC) is a standard of care. Partial nephrectomy (PN) in the setting of metastatic disease is an uncommon occurrence, and we aimed to characterize its utilization in a modern cohort. Methods: The National Cancer Database was reviewed for patients with mRCC from 2010 to 2017. Patients with cTanyNanyM1 who underwent cytoreductive surgery in the form of PN or radical nephrectomy (RN) were compiled. Our primary outcome was survival outcome for patients who underwent PN compared to RN. Secondary outcomes included 30-day readmission, length of stay, and survival outcomes. Results obtained: A total of 13,896 patients with mRCC who underwent cytoreductive surgery were identified. In total, 13,242 underwent RN and 654 underwent PN. The RN population was more likely to have cN positive disease, while the PN population was more likely to have cT1 disease. Length of stay, readmission and 30-day mortality were not significantly different between PN and RN, but overall mortality and 90-day mortality favored PN (p < 0.001). Cox regression for death showed PN with improved overall survival (HR 0.782, p < 0.001). Logistic regression for predictors of cytoreductive PN revealed cT1 and cN0 as significant factors. Overall survival, as seen on KM analysis, identified that PN exhibited improved 2-year (67.1% vs. 52.0%) and 5-year (40.7% vs. 29.2%) overall survival relative to RN (p < 0.001). Conclusions: PN is an infrequent treatment with mRCC and its utilization is stable from 2010 to 2017. Overall survival is significantly better for those undergoing PN, likely due to their favorable oncologic disease characteristics.

Introduction Fournier’s gangrene (FG) is a rapidly progressing necrotizing fasciitis. The Fournier's Gangrene Severity Index (FGSI), in conjunction with the Charlson Comorbidity Index (CCI), has been used as a mortality predictor during hospitalization. Patients with diabetes have also been shown to be at an increased risk for the development of FG. This study explores the potential of using FGSI, CCI, and patient diabetes status in predicting more extensive patient outcomes, including intensive care unit (ICU) admission and length of hospital stay. Methods From 2013 to 2023, inpatient admissions with the diagnosis of FG were selected from the EPIC Clarity database of the Sisters of St. Mary hospital system. Patient demographics, ICU admission, length of hospital stay, medical comorbidities, and calculated FGSI and CCI scores were extracted from selected admissions. Logistic regression and generalized linear regression models were performed for regression analysis. Results A total of 264 patients who met our inclusion criteria were admitted for FG from 2013 to 2023. The patient population was all male with a mean age of 54.7 years. Of the cohort, 127 patients (48.1%) required ICU care, and 44 patients (16.7%) died during admission. Of the 164 patients (62.1%) diagnosed with diabetes, 13 were taking sodium-glucose cotransporter 2 (SGLT-2) inhibitors prior to admission, and 121 were insulin-dependent. No relationship could be found between the use of SGLT-2 inhibitors or insulin and patient outcome. For every one-unit increase in FGSI score, the odds of mortality increased by 1.14 times, the odds of being admitted to the ICU increased by 1.3 times, and the length of hospital stay increased by 1.1 days (p<0.0001). For every one-unit increase in CCI score, the odds of mortality increase by 1.2 times (p=0.003), and the length of hospital stay increased by 0.9 days (p=0.04). Conclusions Insulin-dependent diabetes and the use of SGLT-2 inhibitors are not risk factors for more severe FG. FGSI and CCI scores may be used to predict patient outcomes beyond mortality, including ICU admission and length of hospital stay.